Abstract
Introduction: Acute necrotizing pancreatitis (ANP) is potentially lethal inflammatory process. Recent researches established that presence of multiorgan failure together with pancreatic infection are major determinants of its mortality. But significance of acute gastrointestinal injury AGI in course of ANP is still remaining unclear. So aim of our study was to determine frequency and significance of AGI on severity and mortality of ANP. Material: We performed a prospective observational cohort study of 151 patients which were admitted to single intensive care department during early phase of ANP. Acute gastrointestinal injury was established according to ESICM recommendations. Clinical and laboratorial variables as well as plasma lipopolysaccharide, sCD14 receptors and citrulline concentrations were studied. Results: Different levels of AGI were diagnosed in 141 (93.4%) of patients with ANP. Risk of intestinal dysfunction (1st grade) was detected in 24.5% cases, feeding intolerance (2nd grade) - in 35.8%, intestinal failure (3rd grade) - in 33.2% and critical intestinal failure (4th grade) - in 8.0%. Intestinal (3rd and 4th grade of AGI), respiratory, cardio-vascular and renal failures were independent factors of mortality in multivariate logistic regression model (Wald's criteria 8.441, 5.464, 5.660 and 3.847, accordingly, p˂0.05). Conclusion: AGI is a frequent event during early phase of ANP. Intestinal failure (3rd and 4th grade of AGI) is strongly associated with unfavorable prognosis.
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